Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance (Spanish) Forms
| Form Name | Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance (Spanish) |
| Form # | F242-422-999 |
| Form Revision | 04-2017 |
| Category | Forms » Death |
| Downloads | |
| Form State | Washington |
| Language | Spanish |
| State Description | n/a |
| Claimwire Description | n/a |